.png)
I want to stay on opioids, so what do I do?
A couple of weeks ago I talked about what withdrawal from different families of drugs was like (https://www.sjdpsych.com/post/help-i-can-t-get-off-this-stuff). And I especially talked about withdrawing from the pain medications known as “opioids” (like morphine or Oxycontin®).
I also talked about the fact that sometimes people decide they really don’t want to get off one of these medications. However, for one reason or another, the person who was prescribing this medication won’t do it anymore.
Today I’m going to talk about what to do when you don’t want to quit your medicine but your prescriber won’t prescribe it.
Why would my prescriber stop prescribing?
There are a number of reasons that a prescriber might decide not to prescribe an opioid anymore, even though the patient wants them to.
One possibility is fear.
-Fear that the patient is taking too much and might accidentally mix their
prescribed drug with something – like even a beer or two- that could prove fatal
-Fear that their license might be in jeopardy. If a prescriber is prescribing way more than other prescribers, local authorities and other professionals may be giving them grief.
- Some prescribers have been cut off by pharmacies because they thought the prescriber was prescribing too many opioids or at doses that were too high.
-Fear of liability – that if something happened they would be blamed.
- And undoubtedly there are other reasons that I haven’t thought of.
Another reason to stop is that the medication isn’t working like it’s supposed to.
- Maybe you’re still having a lot of pain, but it isn’t safe to go higher on the med
- Maybe you’re doing less, which in the long run can result in worsening of your pain
and overall quality of life.
-Maybe you have to be on medications for some problem that could be dangerous in
combination with the opioid you’re getting
Why would I not want to quit?
- Maybe even though your prescriber doesn’t think so, you think the medication is
helping, or is at least better than being without it.
- Maybe you’ve stopped it or tried to before, but found yourself thinking about the
medication a lot or all the time, wishing you could have the overall good feelings you
get from having it. In other words, maybe you’re craving the drug
- Maybe you’ve heard about or even gone through withdrawal from the medication and
you’re afraid that could happen again
- Maybe you’re just afraid of what life could be like without it.
So now what do I do?
You can’t force a prescriber to prescribe a drug if they don’t want to. Like I said before, they have to help you either get off the drug or find someone else to prescribe it.
But they don’t have to continue prescribing it.
One obvious thing you can do, if the reason you want to keep using the opioid drug is that it seems to help your pain, is to work with someone, for example a pain specialist, to try to find something that works as well or better.
But if you crave the drug and just don’t want to be without it because it makes you emotionally better, then there are several possibilities.
Naltrexone. This is an interesting drug. It is not an opioid. In fact, it’s an anti-opioid. But for some people, once they’re off their prescription pain killer, this medication can help with some of the craving they feel.
And it can be taken by mouth once a day, or as a shot once a month.
But naltrexone isn’t for everybody. For one thing, if you need an opioid, like for surgery or for a trip to the dentist, the opioid won’t work. The naltrexone blocks it from doing anything.
For another thing, it can be hard on the stomach.
Also, though most people are able to tolerate the drug, it may not give them the feeling they’re looking for. And it may not take away the craving you feel for the opioids you don’t get anymore.
For these people, they may need to be on “opioid maintenance.” That is, they’re kept on or “maintained” on, an opioid. And there are two medications we use for this.
Methadone : You can get methadone from just about any medical professional when it’s for treating pain. But it’s pretty powerful, and most prescribers don’t like to prescribe it.
So methadone is mostly used for people who are addicted to illegal opioid drugs.
Since the 1960s people have been “maintained” on methadone. A couple of doctors had the theory that people who were hooked on drugs were “replacing” something that their brain was missing.
And they figured that if they replaced the missing something with a legal opioid, the addicted person could be freed from the problems their addiction was causing.
And it worked. Thousands of people have been helped to get off street drugs and get into programs to treat their addictions.
But there are a lot of restrictions to methadone use. Methadone for maintenance can only be prescribed in specially licensed clinics. And there aren’t nearly enough clinics to handle the number of people who need this kind of treatment.
Plus, these clinics are pretty much only available in large cities, so people in rural areas don’t usually have access.
Also, this medication is strong and can be dangerous.
So scientists kept trying to find something else for opioid maintenance that would be safer
and available to more people. And what they came up with is something called buprenorphine.
So What is This Stuff?
Buprenorphine for opioid maintenance comes as Subutex®, Suboxone®, Zubsolve® and others. From here on out I’ll just call it bupe. It’s still an opioid. It’s just a lot safer than things like Vicodin® and Oxycontin®.
It doesn’t mean it’s not strong. It just means that it’s harder to get hurt with bupe than it is with some of the other drugs I’ve mentioned.
You can still get very dead if you use bupe with alcohol or any number of other drugs. But it’s less likely to happen than if you use other opioids.
How do you take it: There are different ways that bupe is used. For instance, there’s a transdermal patch (you stick it on your body and it’s absorbed through the skin) that can be used to treat pain.
When it’s being used to treat someone with opioid dependence, it’s used a little differently. You put the medicine in your mouth, then hold it under your tongue and let it slowly absorb into your body. If you just swallow it, the acid in your stomach breaks it down and it doesn’t work.
And to make it even safer, many times bupe is combined in one pill with naloxone. Like naltrexone that I talked about before, naloxone actually works as an anti-opioid. The idea here is that if you try to take too much, the naloxone kicks in and blocks the bupe from working.
Again, I have to stress that you can still hurt yourself with this medication, even with all the things that are done to try to make it safe. It’s just that you have to work a little bit more to cause damage.
Where do you get bupe
Not everybody who prescribes medication can prescribe bupe. It takes a special license and some special training to do this.
But there are a lot more people who prescribe bupe than prescribe methadone and other opioids. This means it’s available to a lot more people who need it.
Your body is still dependent on an opioid. It can still be dangerous to be on it and be on other medications or to drink.
But it’s safer. It can help a lot with craving. And it might be what you need.
Some things to think about:
Realizing that you can't stop a medication very easily, or finding out that you don't want to stop it but you're getting pressure to do so, sucks.
And especially when we're talking about opioids. People are embarrassed to admit that they're dependent on a medication.
But no one ever tries or intends to get hooked. It's what happens to a human body if they're exposed to some kinds of drugs for long enough.
However, there is help for what to do if you are dependent on one of these drugs.
There are medications that can help people who crave opioids or whose bodies depend upon them. Some ways to find this help are listed at the end of this post.
Pain specialists especially may be knowledgeable about tricks and procedures that may make pain better. Seeing someone in this specialty may be helpful.
If you want to be off opioids but are embarrassed to admit you have this problem, members of Narcotics Anyonymous (NA) may be sympathetic and helpful. Contact information is given about this organization as well.
To find someone near you who prescribes bupe, paste the following url into your browser: https://www.samhsa.gov/resource/dbhis/buprenorphine-practitioner-locator
For help to locate treatment of any kind including methadone paste the following into your browser: https://www.samhsa.gov/find-help/national-helpline
For help locating a Narcotics Anonymous meeting near you: paste this web address into your browser: https://www.na.org/meetingsearch/
Illustration of thinking person by @CanStock Photo Inc/leremy
Illustration of doctor refusing by @CanStock Photo Inc./elnur
Illustration of scientist by @Can Stock Photo Inc/krugli